OxyContin's 12-hour problem • Hacker News Board

Re: OxyContin's 12-hour problem

#61

Post by jrs235 » Sat, May 07, 2016, 2:32 PM UTC

hashmymustache wrote: post #43

peteretep wrote: post #29

> it appears they offered a cushy job to a > government official in exchange for favorable > regulatory treatment I suspect that that sentence is legally actionable as slander, as well as being an (apparently) completely baseless claim of illegal activity.

You are wildly off base to the point that you seem like a shill. Learn about tort law and the first amendment. Besides it not being injurious or necessarily false, It involves a public official so good luck proving actual malice.

Your response seems unnecessarirly harsh. Please be more civil (HN strives for civility) and understand that HN has a global audience with differing laws (the parent could use this same perspective that HN is global).

Re: OxyContin's 12-hour problem

#62

Post by maxerickson » Sat, May 07, 2016, 2:37 PM UTC

vinceguidry wrote: post #55

maxerickson wrote: post #50

Earlier quoted context omitted.

The patent and the marketing didn't make hydrocodone less viable as an alternative. I mean, the doctors can see that information coming from the company can be problematic and be cautious of it. I guess they ideally shouldn't have to be, but that's not the world. Personally, I'd be fine dismantling Purdue for something like this. We need to start recognizing that large institutions make mistakes for reasons that can'…

I'm not opposed to that, but you also need to fix broken systems, otherwise the problem will recur.

To me the big flaw is that FDA approval and the associated studies were enough to drive the prescriptions. It would be pretty easy for the healthcare system to systematically run their own comparative studies on new drugs (during the course of normal care). There's some ethical mumbo jumbo around best possible care to look at, but I think being cautious about unfamiliar products is probably a nice offset to those concerns.

I find myself thinking back to this discussion: https://news.ycombinator.com/item?id=11627213

Where I quoted Peter Pronovost (the checklist guy) saying:

The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine.

This is literally a case of boxes 1 and 2 being checked, with little attention to box 3.

Re: OxyContin's 12-hour problem

#63

Post by DanielBMarkham » Sat, May 07, 2016, 2:42 PM UTC

If this is true, this is one of the biggest stories of the year so far. There will be a huge class action lawsuit. Wow. It boggles the mind the number of people harmed here -- if this is true.

I wonder, for those people who do not get the full 12-hour effect, are they eliminating the drug quicker or metabolizing it into its bioactive agent quicker? It could be that not only are they going into withdrawal, they're actually experiencing more of an effect than they are supposed to. (I do not know. It'd be interesting for somebody who knew something to chime in here.)

Re: OxyContin's 12-hour problem

#64

Post by notsotrue » Sat, May 07, 2016, 2:43 PM UTC

puppetmaster3 wrote: post #2

It's quite simple: Don't do drugs. Next question please.

I suffer from avascular necrosis, where my large bone joints are dying from a lack of blood flow. The bone breaks down (sever acute pain), chews the shit out of the cartilage (chronic inflammation pain), and movement exacerbates both. I still do the excises, as each joint will eventually be replaced, and strong muscles decrease dislocation chances, but this provides no pain relief, and only causes to fatigue the muscles. After 7 surgeries, 3 joint replacements, you begin to realize that the average person has no idea what pain is. A broken bone isn't pain, it's an inconvenience.

I refuse to use opioids anymore, I can't code on them, they muddle your brain. But I wouldn't wish this life on anyone, not even the morons who glibly state that all you have to do is not take drugs.

Re: OxyContin's 12-hour problem

#65

Post by ghaff » Sat, May 07, 2016, 2:47 PM UTC

manyxcxi wrote: post #60

pappyo wrote: post #7

The pervasiveness of OC provided by doctors is amazing. Even as of a year ago, I went into the hospital for back pain and left with a script for two fist fulls of oxy. I looked at the doctor and legitimately thought he was trying to get me hooked. And this was at a world renowned hospital. I have to wonder if Purdue is involved in some kickbacks to Dr's who (over)prescribe.

It's kind of scary how quickly doctors seem to prescribe it. I've had a doctor prescribe me some for everything from the flu to a mild ankle sprain. That being said, I always used to wonder if it was because I can't take any NSAIDs- it's acetaminophen or nothing for me. This usually means where they could get away with a big dose of Ibuprofin for pain and anti-inflammatory I wind up with oxycodone and prednisone. Whi…

And acetaminophen has its own set of problems. It's at least a reasonable question whether it would have been approved as an over the counter drug had its level of liver toxicity been known at the time.

Re: OxyContin's 12-hour problem

#66

Post by biesnecker » Sat, May 07, 2016, 2:51 PM UTC

DanBC wrote: post #46

CydeWeys wrote: post #22

Earlier quoted context omitted.

I fractured my tibia recently and the urgent care gave me a short prescription for Percocet (which contains oxycodone like Oxycontin and also acetaminophen). I didn't end up picking it up as I don't have a car and mobility is understandably limited when you've fractured your tibia, but the past the first day the pain wasn't bad enough to need it anyway, and ibuprofen sufficed. And I am a wimpy person who does not do…

> Experiencing pain has a limited risk potential in most people, especially when the pain is linked to a temporary condition. People living with long term pain are at increased risk for death by suicide. That doesn't mean we should just hand out opiates (which should not be used for chronic pain), but that we should take pain relief a bit more seriously. Living in pain sucks .

"Especially when the pain is linked to a temporary condition."

I think that's the important point in the original comment.

Re: OxyContin's 12-hour problem

#67

Post by guard-of-terra » Sat, May 07, 2016, 2:52 PM UTC

Why don't patients for whom OxyContin does not work 12-hours ask their doctor for some another drug? With smaller interval, generic, and much cheaper?

Would a doctor refuse to prescribe different, much cheaper drug, keeping them on expensive drug that does not work? Should not they then lose licenses?

The whole prescription medicine system always seemed evil to me.

Re: OxyContin's 12-hour problem

#68

Post by notsotrue » Sat, May 07, 2016, 2:54 PM UTC

DanBC wrote: post #46

CydeWeys wrote: post #22

Earlier quoted context omitted.

I fractured my tibia recently and the urgent care gave me a short prescription for Percocet (which contains oxycodone like Oxycontin and also acetaminophen). I didn't end up picking it up as I don't have a car and mobility is understandably limited when you've fractured your tibia, but the past the first day the pain wasn't bad enough to need it anyway, and ibuprofen sufficed. And I am a wimpy person who does not do…

> Experiencing pain has a limited risk potential in most people, especially when the pain is linked to a temporary condition. People living with long term pain are at increased risk for death by suicide. That doesn't mean we should just hand out opiates (which should not be used for chronic pain), but that we should take pain relief a bit more seriously. Living in pain sucks .

I illegally use marijuana, not for the pain relief, it's not any more effect in my case than a bottle of Jack. But it gives me a pocket of time where I can just feel okay, mentally, knowing that I will never live another day without pain.

The medical community focuses too much on symptom/treatment, and not enough on quality of life. I'm not saying that marijuana is an answer here, and I completely accept anyone who says I'm just using my pain as an excuse to get high, but it lets me feel emotion again, something you wrap up so tight in order to deal with the pain, you forget how to laugh and cry.

Re: OxyContin's 12-hour problem

#69

Post by saulrh » Sat, May 07, 2016, 2:59 PM UTC

alttab wrote: post #57

imglorp wrote: post #25

Earlier quoted context omitted.

It is the appearance of impropriety, straight out of any corporate anti-bribery ethics training. In this case, it appears they offered a cushy job to a government official in exchange for favorable regulatory treatment, leading a very lucrative business. It appears dirty but maybe can't be proven.

Another way to look at it was in working with Purdue, he was able to demonstrate his ability to define and walk around FDA approvals by understanding and guiding product language to get approval. This is a valuable skill. Purdue probably wanted someone like that on their product development team who could influence drug design early on which would make it less costly and more efficient to get drugs approved in the fu…

> Another way to look at it was in working with Purdue, he was able to demonstrate his ability to define and walk around FDA approvals by understanding and guiding product language to get approval.

Isn't subverting the system like that almost as improper as doing it from the other side? Not as obviously, possibly not as strongly, but from having been in research myself, knowing the little details like that is often good enough to get things through all by itself, completely without regard for whether your research works.

Re: OxyContin's 12-hour problem

#70

Post by wpietri » Sat, May 07, 2016, 3:03 PM UTC

pappyo wrote: post #7

The pervasiveness of OC provided by doctors is amazing. Even as of a year ago, I went into the hospital for back pain and left with a script for two fist fulls of oxy. I looked at the doctor and legitimately thought he was trying to get me hooked. And this was at a world renowned hospital. I have to wonder if Purdue is involved in some kickbacks to Dr's who (over)prescribe.

I think this is a natural outcome of a system where drugmakers can spend billions on advertising, marketing, and sales reps. Those are three activities with basically no ethical standards; their only job is to make the graph go up and to the right.

My solution: ban all of that. Let doctors learn about new drugs via means funded by the doctors themselves. Before the Internet, that would have been difficult. But now you can imagine specialist medical journals, or special AMA committees. Manufacturers would still try to manipulate that, but doctors wouldn't be grossly outgunned.